Narvaez-Lugo Jessica, Cáceres William W, Toro Doris H, Pérez-González Manuel R, Almodovar Alvin A, Maldonado-Mercado Awilda M, Salgado Norma, Rivera-Sanfeliz Gerant M
Department of Internal Medicine, Hematology-Oncology Section, VA Caribbean Healthcare System, San Juan, Puerto Rico 00921.
Cancer Control. 2008 Jan;15(1):80-5. doi: 10.1177/107327480801500110.
Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients.
We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST).
Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate.
In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.
肝细胞癌（HCC）是全球常见的恶性肿瘤，预后较差。尽管手术和肝移植能带来更好的治疗效果，但由于疾病进展、缺乏供体或存在合并症，大多数患者不适合接受这些治疗。已开发出几种经皮治疗方法，如经动脉化疗栓塞术（TACE）和经皮乙醇注射疗法（PEIT）用于局部控制，有可能提高这些患者的生存率。
我们回顾性分析了2000年至2005年在波多黎各退伍军人事务部加勒比医疗系统接受TACE、PEIT或两者联合治疗的33例HCC患者，以评估耐受性、反应和生存率。使用横断面计算机断层扫描成像对患者进行评估，根据实体瘤疗效评价标准（RECIST）确定反应情况。
33例男性患者接受了治疗，平均年龄66岁。平均肿瘤大小为5.6厘米，范围从2厘米至16厘米。所有患者均患有肝硬化，最常见的病因是酒精滥用和丙型肝炎。28%的患者观察到客观影像学部分缓解，48%的患者病情稳定。大多数患者有治疗反应，表现为肿瘤坏死和对比增强减弱。接受TACE和PEIT联合治疗的患者反应率更高，病情更稳定，但与单独接受TACE或PEIT治疗的患者相比，生存率无差异。全组患者的中位生存期为2年。死亡原因包括肿瘤进展、肝衰竭、胃肠道出血和感染。初始肿瘤大小和Child-Pugh分级在生存率方面无显著差异。
在目前不进行肝移植的波多黎各，经皮治疗对于不适合手术且疾病局限于肝脏的患者是有效的局部治疗方法。
